IN THE CIRCUIT COURT FOR THE SIXTEENTH JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS IN THE MATTER OF THE ESTATE OF __________________________________ A Disabled Person Case No.___________________________ STATEMENT OF RIGHT TO DISCHARGE GUARDIAN OR MODIFY GUARDIANSHIP ORDER To: ___________________________________ ______________________________________ ______________________________________ As a result of a proceeding in the Probate Division of the Circuit Court of DeKalb County, you have been adjudged a disabled person, and a guardian has been appointed for you. The duties of your guardian have also been determined in this proceeding. If at any time hereafter, you should find that your capacity to perform the tasks necessary for the care of your person or the management of your estate have changed so as to warrant the discharge of your guardian or the modification of your guardian’s duties, you may petition the Court for such an Order. You may communicate your request for an Order of Discharge or Modification by writing to the Presiding Judge of the Probate Division, DeKalb County Courthouse, 133 W. State St., Sycamore, IL 60178. Please send a copy of any such request to the guardian appointed for you and to the guardian’s attorney of record. Dated____________________________, 20_____ Enter:____________________________________ Judge CERTIFICATE OF MAILING I, Maureen A. Josh, Clerk of the Circuit Court of DeKalb County, do hereby certify that I have mailed to the person named herein above a copy of this Notice, by depositing the same in the U.S. Mail, postage prepaid, at Sycamore, Illinois 60178, the __________ day of ____________________________, 20_____. _________________________________________ Clerk of the Circuit Court Probate11 9/12/05 American LegalNet, Inc. www.FormsWorkflow.com